Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Introduction, body and reference page LM is an 86-year-old female admitted to the emergency department with delirium. Her spouse is with her and verifies that LM adheres to the medications she is currently prescribed. She does not self-monitor her BP or heart rate at home. PMH: A Fib was diagnosed 1 month ago HTN x 10 years CKD x 5 years Osteoarthritis x 7 years GERD x 20 years Medications: Digoxin 0.25 mg QD Metoprolol XL 25mg QD Warfarin 3 mg QD APAP 650 mg TID Omeprazole 20mg QD Multivitamin QD Allergies: NKDA Social History: Married to husband for 57 years No smokin

Enhancing Drug Therapy – Managing Pharmacokinetic and Pharmacodynamic Changes

Pharmacokinetics deals with the study of drug activity when it enters the body. It involves four processes which include absorption from the route of administration to when the drug enters the body circulation, distribution to various tissues and fluids in the body, metabolism, which is the process of transformation of the medicine to simpler substances that can be absorbed in the body, and elimination where the drug is removed from the body. However, some medications may not be eliminated from the body completely. These processes determine the period the drug takes to give a response, the intensity, and the rate of onset. Pharmacodynamics involves the drug’s actions in the body, for example, side effects and mechanism of action. This process involves physiological and biochemical measures. The healing process can be slowed by various factors that affect the pharmacokinetics and pharmacodynamics of the patient (Anwar et al., 2021). These factors include the patient’s age, gender, comorbidities, and medications that the patient is using. In this case scenario, LM is an 86-year-old female with delirium. She is admitted to the emergency departed accompanied by her spouse, who confirms that she is compliant with medication according to the prescription given by her doctor. The spouse verifies that she does not check her blood pressure and heart rate at home. The patient does not have any known food and drug allergy and uses the following medications; APAP 650mg TID, multivitamin QD, warfarin 3mg OD, metoprolol XL 25mg QD, digoxin 0.25mg OD, and omeprazole 20mg QD. The medications that the patient is currently on, age, sex, and the patient’s past medical history affect the patient’s pharmacodynamics and pharmacokinetics.

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Selected Factors That Might Influence the Pharmacokinetic and Pharmacodynamic Processes in the Patient

LM is 86 years old, and as a person ages, the elimination of the drug by the kidneys decreases, especially from age 40, when the glomerular filtration rate decreases by 8mL/min/1.73m2. Despite the altered glomerular filtration rate, serum creatinine levels remained within the normal range because of reduced activity in older people and decreased muscle mass. In older patients, the function of baroreceptors is diminished, and the tone of peripheral veins is reduced, thus reducing the response of the drug in the cardiac, vascular, and pulmonary tissues. Her underlying conditions, such as osteoarthritis, GERD, hypertension, chronic kidney disease, and atrial fibrillation, can influence the distribution, absorption, and elimination of drugs in the body due to the loss or decreased functions of various systems. For example, the patient suffers from CKD, which can affect the excretion of drugs from the body due to impaired renal function. Using different medications to manage various conditions can reduce the bioavailability of some drugs and also reduce first-pass metabolism in the liver—some drugs, such as digoxin cause hyperkalemia associated with reduced excretion from the renal system. Changes in pharmacodynamics include increased sensitivity to various classes of drugs, such as cardiovascular drugs and anticoagulants. On the other hand, changes in pharmacokinetics involve an increased period of elimination of drugs due to an increase in the volume of distribution, especially in lipid-soluble medications, which causes decreased hepatic and renal clearance of drugs.